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Does all learning disabled have APD ?

By Mr. Venugopal M B : Speech Language Pathologist

Auditory Processing Disorder (APD) previously known as "Central Auditory Processing Disorder" (CAPD) is a disorder in how auditory information is processed in the brain. It is not a sensory (inner ear) hearing impairment; individuals with APD usually have normal peripheral hearing ability. These children can't process the information they hear in the same way as others because their ears and brain don't fully coordinate. Something adversely affects the way the brain recognizes and interprets sounds, most notably the sounds composing speech. Children with APD often do not recognize subtle differences between sounds in words, even when the sounds are loud and clear enough to be heard. These kinds of problems typically occur in background noise, which is a natural listening environment. So children with APD have the basic difficulty of understanding any speech signal presented under less than optimal conditions.

APD is an umbrella term that describes a variety of problems with the brain that can interfere with processing auditory information. Auditory processing disorder can be a congenital or an acquired condition (for example; resulting from ear infections and head injuries) which refers to difficulties in the processing of auditory information within the central nervous system.

Auditory processing disorder is commonly seen in school going children due to frequent ear infections. Auditory processing disorder is recognized as a major cause of dyslexia. As Auditory processing disorder is one of the more difficult information processing disorders to detect and diagnose, it may sometimes be misdiagnosed as Attention Deficit Disorders /Attention Deficit Hyperactivity Disorder, Aspergers and other more severe forms of autism, but it may also be a co morbid aspect of those conditions if it is considered a significant part of the overall diagnostic picture.

However, the ability to detect the presence of sounds is only one part of the processing that occurs in the auditory system. So, most children with APD do not have a loss of hearing sensitivity, but have a hearing problem in the sense that they do not process auditory information normally. If the auditory deficits aren't identified and managed early, many of these children will have speech and language delays and academic problems.

Auditory processing disorder shares common symptoms in areas of overlap such that professionals who were not aware of auditory processing disorder would diagnose the disabilities as those which they were aware of. Auditory processing disorder can also be confused with Language Processing Disorder. Auditory processing disorder can exhibit problems with determining the direction of sounds, difficulty perceiving differences between speech sounds and the sequencing of these sounds into meaningful words, confusing similar sounds such as "hat" with "bat", "there" with "where", etc. Fewer words may be perceived than were actually said, as there can be problems detecting the gaps between words, creating the sense that someone is speaking unfamiliar or nonsense words. A problem relating what has been said with its meaning, despite obvious recognition that a word has been said, as well as repetition of the word. Separating speech sounds from background noise, such as the sound of a radio or television, it can be difficult to understand speech, depending on the severity of the auditory processing disorder. Using a telephone can be problematic, due to low quality audio, poor signal, intermittent sounds and the chopping of words can be a problem for someone with Auditory processing disorder to cope with, in comparison with someone with normal auditory processing (hearing). Many who have auditory processing disorder subconsciously develop visual coping strategies, such as lip reading, reading body language, and eye contact, to compensate for their auditory deficit, and these coping strategies are not available when using a telephone.

There are many possible causes of APD. They can include head trauma, lead poisoning, and chronic ear infections. It can also be inherited or genetic. Because there are many different possibilities, each person must be assessed individually. Persons with this condition often have trouble paying attention to and remembering information presented orally, cope better with visually acquired information, have problems carrying out multi-step directions given orally, need to hear only one direction at a time, appear to have poor listening skills, and need people to speak slowly, need more time to process information. It appears to others as a problem with listening.

Problem Areas for children with APD

The five main problem areas that can affect both home and school activities in children with APD are:

1. Auditory Figure-Ground Problems: This is when the child can't pay attention when there's noise in the background. Noisy, low-structured classrooms could be very frustrating.

2. Auditory Memory Problems: This is when the child has difficulty remembering information such as directions, lists, or study materials. It can be immediate (i.e., "I can't remember it now") and/or delayed (i.e., "I can't remember it when I need it for later").

3. Auditory Discrimination Problems: This is when the child has difficulty hearing the difference between sounds or words that are similar (COAT/BOAT or CH/SH). This problem can affect following directions, reading, spelling, and writing skills, among others.

4. Auditory Attention Problems: This is when the child can't maintain focus for listening long enough to complete a task or requirement (such as listening to a lecture in school). Although health, motivation, and attitude might also affect attention, among other factors, a child with CAPD cannot (not will not) maintain attention.

5. Auditory Cohesion Problems: This is when higher-level listening tasks are difficult. Auditory cohesion skills — drawing inferences from conversations, understanding riddles, or comprehending verbal math problems — require heightened auditory processing and language levels. They develop best when all the other skills (levels 1 through 4 above) are intact.

Strategies that might help children with APD

Strategies applied at home and school can alleviate some of the problem behaviours associated with APD. Because it's common for children with CAPD to have difficulty following directions, for example, these tactics might help:

Since most children with APD have difficulty hearing a mild noise, it's very important to reduce the background noise at home and at school.
Have your child look at you when you're speaking.
Use simple, expressive sentences.
Speak at a slightly slower rate and at a mildly increased volume.
Ask your child to repeat the directions back to you and to keep repeating them aloud (to you or to himself or herself) until the directions are completed.
For directions that are to be completed at a later time, writing notes, wearing a watch, and maintaining a household routine also help. General organization and scheduling also can be beneficial.
Provide your child with a quiet study place.
Maintain a peaceful, organized lifestyle.
Encourage good eating and sleeping habits.
Assign regular and realistic chores, including keeping a neat room and desk.
Build your child's self-esteem.